This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Meeting abstract

A 20-community randomized controlled trial, the Alcohol Action in Rural Communities
(AARC) project, provided the opportunity to examine the cost-effectiveness of screening
and brief intervention (SBI) delivered simultaneously in general practice (GP), pharmacy,
and emergency department (ED) settings and the community level impact of the SBI on
problem drinking. For the GP- and pharmacy-delivered SBI, decision models and scenario
analysis assessed outcomes and costs in the 10 experimental communities of the trial.
For the ED-delivered SBI, a randomized controlled trial design was used to examine
the cost-effectiveness of mailed personalized feedback. For both the GP- and pharmacy-delivered
SBI, the most cost-effective outcome was to increase screening alone: GPs and pharmacies
screening all patients achieved an incremental cost-effectiveness ratio (ICER) of
AUD $197 and AUD $29, respectively, per risky drinker who reduced drinking. The ED-based
SBI resulted in a reduction of 2.6 fewer drinks per week at an average cost of $5.55
per patient and an ICER of $2.13 per one standard drink reduction in average weekly
consumption. In addition to cost-effectiveness, the AARC community approach provided
the opportunity to analyze the effect of SBI on community level outcomes. Currently,
19% of risky drinkers in a community visit a GP and reduce their drinking, which would
increase to 36% if all patients got SBI. Similarly, 23% of risky drinkers in a community
visit a pharmacy and reduce their drinking, which would increase to 34% if they all
got SBI. Although our results confirm SBI is cost-effective, the impact at the community
level is unclear: if all GPs and pharmacists delivered SBI to all their risky drinking
patients, only 34-36% would reduce their drinking. A trial that assessed the impact
of SBI delivered in multiple settings simultaneously on community level indicators
of alcohol harm would move the field toward demonstrating the cost benefit, as well
as cost-effectiveness, of SBI.